Rabies Vaccine

Class: Vaccines
ATC Class: J07BG01
VA Class: IM100
Brands: Imovax, RabAvert

Introduction

Inactivated virus vaccine. Rabies vaccine contains rabies virus antigens and is used to stimulate active immunity to rabies infection. Commercially available in the US as human diploid-cell rabies vaccine (HDCV; Imovax) and purified chick embryo cell culture rabies vaccine (PCECV; RabAvert). Other rabies vaccines (e.g., vero cell rabies vaccine, duck embryo rabies vaccine, nerve tissue vaccine [NTV]) may be available in other countries.

Uses for Rabies Vaccine

Prevention of Rabies

Prevention of rabies in children, adolescents, and adults exposed to or at increased risk of exposure to rabies disease or virus.

Rabies is a viral infection transmitted by saliva of infected mammals, most commonly wild, terrestrial carnivores (e.g., skunks, raccoons, foxes, coyotes) or bats. In the US, the greatest risk for naturally acquired rabies is from contact with and bites from insectivorous bats. Following exposure and infection, rabies virus usually moves along a neural pathway and enters the CNS. After entrance into the CNS, the virus is unlikely to be affected by antirabies antibodies and encephalomyelitis usually develops and almost always is fatal. In the US, approximately 16,000–39,000 individuals receive rabies postexposure prophylaxis each year. Although there were 27 rabies cases reported in the US during 2000–2008, these individuals evidently did not receive rabies postexposure prophylaxis. Rabies prevention and control strategies and elimination of canine rabies virus variants and enzootic transmission among dogs have lowered the number of rabies cases in the US to an average of 1–2 per year. However, worldwide, rabies is much more common and at least 55,000 rabies-related deaths occur each year.

USPHS Advisory Committee on Immunization Practices (ACIP) and AAP recommend preexposure vaccination with rabies vaccine (series of 3 doses with booster doses when indicated) in children, adolescents, and adults who are or will be at increased risk of exposure to the virus. (See Preexposure Vaccination Against Rabies in High-risk Groups under Uses.)

Postexposure prophylaxis with a regimen that includes local wound treatment, rabies vaccine (series of 4 or 5 doses), and a single dose of rabies immune globulin (RIG) is recommend for previously unvaccinated children, adolescents, and adults following potential rabies exposure. Postexposure prophylaxis with a regimen that includes local wound treatment and a series of 2 booster doses of rabies vaccine (without RIG) is recommended for previously vaccinated children, adolescents, and adults following potential rabies exposure. (See Postexposure Prophylaxis of Rabies under Uses.)

Preexposure Vaccination Against Rabies in High-risk Groups

Preexposure vaccination in children, adolescents, and adults who are or will be at risk of exposure to rabies virus.

Preexposure vaccination does not eliminate the need for prompt postexposure prophylaxis if an exposure to rabies occurs. (See Postexposure Prophylaxis of Rabies under Uses.)

Need for rabies preexposure vaccination depends on the nature of risk and associated level of potential exposure. Consider preexposure vaccination for individuals whose risk of rabies exposure is greater than that of the general p...